1. University of Cape Town Carcinoma of the cervix Digital Pathology Collection Case 15 2011 Ref XXVI:vi:25

2. University of Cape Town is entirely preventable From this...to this Image used with permission

3. University of Cape Town Early invasive cervical squamous carcinoma - removed by hysterectomy Advanced cervical carcinoma with urinary obstruction - removed at autopsy Image 1350 from Peir Digital Library – public access image database http://peir.path.uab.edu University of Alabama at Birmingham, Department of Pathology UCT pathology teaching collection Image used with permission

4. University of Cape Town Clinical data The patient was an elderly woman who presented with post- menopausal bleeding, a foul smelling vaginal discharge, pain in the lower abdomen, dysuria and urinary frequency. On vaginal examination a large fungating growth of the cervix was found. She was given radiotherapy (palliative) but two weeks later she became mentally confused, then comatose, and died.

5. University of Cape Town At autopsy The specimen shows, in the lower half, the bisected uterus and cervix (flapped open) and base of bladder. RL

6. University of Cape Town At autopsy The specimen shows, in the lower half, the bisected uterus and cervix (flapped open) and base of bladder. All these are extensively infiltrated by tumour tissue. RL

7. University of Cape Town Just above the bladder the right ureter disappears into tumour. Both ureters are dilated, the right more so. The right kidney is atrophied while the left kidney is enlarged. This indicates that obstruction of the right ureter preceded that of the left by a long enough interval to allow some compensatory hypertrophy of the left kidney. RR

8. University of Cape Town Comment Most patients with stage IV carcinoma of the cervix die in uraemia (renal failure) – this is explained by the anatomical proximity of the ureters to the cervix, just before they enter the bladder. Advanced cervical carcinomas extend directly into contiguous tissues – vagina, rectum, bladder, ureters, paracervical tissue. Obstruction of the ureters by tumour extension causes back pressure on the kidney, with dilatation of the renal pelvis and calyx, and atrophy of the functional renal parenchyma (=hydronephrosis). Infection (pyelonephritis) often supervenes.

9. University of Cape Town A useful link Run through images 1 – 15 (covering cervix and vagina) on this WebPath page http://library.med.utah.edu/WebPath/FEMHTML/FEMIDX.html#2 http://library.med.utah.edu/WebPath/FEMHTML/FEMIDX.html#2

10. University of Cape Town A selection of cases from the Digital Pathology Collection by the Department of Clinical Laboratory Sciences University of Cape Town is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 2.5 South Africa Licence The full Digital Pathology Collection is accessible at www.digitalpathology.uct.ac.za If you would like to use an image or other item from our site that is not labelled with the Creative Commons Licence Logo, please contact the curator for permission.curator